Bill To:


ROOT INSURANCE COMPANY
80 EAST RICH STREET - SUITE 500
COLUMBUS, OH 43215-5249

Services Rendered To:


Vehicle Owner
5600 Boulder Way
Las Vegas, NV 89122
Policy # 68ZJKL


Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  4. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  5. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  6. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    2
    $500.00
  8. 302 Hand Light (# Used)

    $5.00
    1
    $5.00
  9. 402 Fire/Police Services (Per Hour)    

    $100.00
    1
    $100.00
  10. 326 Safety Fest (# Used)

    $2.50
    2
    $5.00
  11. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  12. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 11787 FM 730 North - Azle, Texas

    Ordinance Info: Briar-Reno Cost Recovery Amendment

Subtotal $1,443.00
Total Due $1,443.00


Updated
January 11, 2021 @ 5:31 pm

Invoice updated by Geoffrey.

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